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Hard Deposits and Exploring

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Presentation on theme: "Hard Deposits and Exploring"— Presentation transcript:

1 Hard Deposits and Exploring

2 Hard Deposits and Exploring
Objectives Describe calculus and name the various surfaces on which it can form. Describe the similarities and differences between supragingival and subgingival calculus deposits. Name 3 methods for identification of supragingival calculus and 5 methods for identification of subgingival calculus. Describe the process of calculus formation. Compare the hardness of calculus to that of enamel, dentin, cementum, and bone.

3 Hard Deposits and Exploring Objectives Cont.
Discuss the relationship between calculus and dental disease. Identify 3 modes for attachment of calculus to a tooth surface. Describe the composition of calculus. Identify 6 uses of a dental explorer. Describe the design and use of the #17, #23, and ODU 11/12 explorers. Demonstrate appropriate use of the #17, #23, and ODU 11/12 explorers on the dentoform.

4 Hard Deposits Calculus Calcified bacterial plaque
Hard, tenacious mass forming on teeth (primary or permanent), dentures, & other dental appliances

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7 Hard Deposits Location Supragingival Subgingival

8 Hard Deposits Identification Supragingival calculus
Subgingival calculus

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10 Hard Deposits Calculus formation
Pellicle --> (colonization) --> Plaque --> (mineralization) --> Calculus Saliva provides elements for calcification of supragingival deposits Gingival sulcus fluid provides elements for mineralization of subgingival deposits Average time for plaque to mineralize into calculus is 12 days (Range= 10 to 20 days) Mineralization of plaque may begin as soon as 12 to 24 hours Forms in layers parallel with tooth surface Incremental lines form between layers of calculus

11 Hard Deposits Hardness of calculus % inorganic substance 96% enamel
65% dentin 45-50% cementum/bone **the higher the inorganic %, the greater the degree of calcification

12 Hard Deposits Relationship to disease Calculus is a plaque haven
Calculus is the result (NOT the cause) of pocket formation Plaque forming on top of calculus is nearly impossible to remove (rough surface harbors plaque; tears floss) If calculus is removed, the smooth tooth surface makes plaque removal effective Calculus holds toxic by-products of plaque in contact with gingival tissues

13 Hard Deposits Modes of attachment
Acquired pellicle- easily removed because there is no mechanical interlock Mechanical interlock- locked into irregularities (rough cementum, caries, enamel cracks). Difficult to remove and difficult to assess when complete Direct contact between tooth and calculus matrix- difficult to remove

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15 Hard Deposits Composition Mature calculus
75-85% inorganic components (calcium, phosphate, trace elements, fluoride, hydroxyapatite crystals) 15-25% water and organic components (microorganisms, desquamated epithelial cells, leukocytes)

16 Exploring Uses of the explorer - Detection of:

17 Exploring Design Working end Shank flexible, wire-like
circular in cross-section last 1-2mm is referred to as the TIP tapers to a sharp POINT single-ended or double-ended (paired or dissimilar ends) Shank straight or curved very flexible

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19 Exploring #17 Explorer Tip is at a right angle to the shank
Used supragingivally and subgingivally but NOT for caries detection in pits and fissures Good for deep pockets and anterior teeth

20 Exploring #23 Explorer “Shepard’s hook”
Used primarily for caries detection (use is now controversial- some evidence that clinician may actually penetrate thin but sound enamel with explorer tip) Does not adapt well subgingivally

21 Exploring ODU 11/12 Double ended with paired working ends
Works well in all segments with shallow sulcus depths

22 Exploring Tactile sensitivity
Ability to distinguish relative degrees of roughness and smoothness Takes a lot of time and effort to refine

23 Exploring Technique Light (no blanching), modified pen grasp
Intraoral fulcrum on same arch (except maxillary posterior where it may be impossible to fulcrum on same arch) Carefully insert into sulcus at distal line angle SIDE of tip should be against tooth BACK will reach junctional epithelium Do not direct POINT apically Critical that explorer reaches the base of the sulcus

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25 Exploring Technique (cont.)
Adapt so TIP is flush against the tooth (Adaptation= placement of working end against tooth) Use an exploratory stroke (feeling) Pull motion from base of sulcus to marginal gingiva “Bump” over large pieces of calculus; “drag” over smaller pieces; “fall” into large areas of decay; bump over or fall into defective restorative margins; smooth tooth surface

26 Exploring Stroke direction
Vertical and oblique strokes should be used. This directs the explorer at a right angle to the deposit. Horizontal strokes should be avoided. They may cause the explorer to run parallel to the deposit so it will not be detected. Point is directed toward JE- very dangerous! Extend strokes at least 1/2 way across the interproximal surfaces. Roll the explorer in your fingers to maintain adaptation Use wrist action, NOT finger action

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28 Exploring Practicing exploring techniques Posterior techniques

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32 The following slides will give you an example of different degrees of calculus build up:

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